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The standard of care is strictly avoiding the culprit nut and treating accidental reactions symptomatically. To evaluate potential therapeutic options for desensitizing patients with IgE\u2010mediated tree nut allergy, we systematically searched three bibliographic databases for studies published until January 2024. We looked for active treatments of IgE\u2010mediated allergy to tree nuts (walnut, hazelnut, pistachio, cashew, almond, pecan, macadamia nut, and brazil nut). We focused on allergen\u2010specific immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous (EPIT), or subcutaneous (SCIT) delivery, or other disease\u2010modifying treatments. We found 19 studies that met our criteria: 3 studies investigated sublingual immunotherapy, 5 studied oral immunotherapy to a single tree nut, and 6 used multi\u2010food oral immunotherapy with or without omalizumab. The remaining studies investigated the effectiveness of monoclonal antibodies or IgE\u2010immunoadsorption in multi\u2010food allergic patients, including patients with tree nut allergy. The heterogeneity of the studies prevented pooling and meta\u2010analysis. Oral immunotherapy, single or multi\u2010nut, with or without omalizumab, was the most studied approach and appears effective in conferring protection from accidental exposures. Omalizumab monotherapy is the only approved alternative management for reducing allergic reactions that may occur with accidental exposure.<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/pai14132-fig-0003-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p>","DOI":"10.1111\/pai.14132","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T14:09:38Z","timestamp":1715350178000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Current options in the management of tree nut allergy: A systematic review and narrative synthesis"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6658-4828","authenticated-orcid":false,"given":"Maria","family":"Pasioti","sequence":"first","affiliation":[{"name":"Allergy Department, 2nd Paediatric Clinic National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9204-1923","authenticated-orcid":false,"given":"Paraskevi","family":"Xepapadaki","sequence":"additional","affiliation":[{"name":"Allergy Department, 2nd Paediatric Clinic National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander G.","family":"Mathioudakis","sequence":"additional","affiliation":[{"name":"Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health The University of Manchester  Manchester UK"},{"name":"North West Lung Centre, Wythenshawe Hospital Manchester University NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Lakoumentas","sequence":"additional","affiliation":[{"name":"Allergy Department, 2nd Paediatric Clinic National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Efstathiou","sequence":"additional","affiliation":[{"name":"Allergy Department, 2nd Paediatric Clinic National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos G.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Allergy Department, 2nd Paediatric Clinic National and Kapodistrian University of Athens  Athens Greece"},{"name":"Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Britannica The Editors of Encyclopaedia. \u201cnut\u201d. 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